The importance of being a neurologist (during a dramatic pandemic)

Dear Editor,

We are facing an unexpected and catastrophic COVID-19 pandemic that is putting Health Care Systems through the wringer all over the world. Beside the battle to contain infection, the rising need of intensive care units and the aim of curing as many people as we can, all of us are called to a deep personal effort. Social distancing is something completely far from our habits and from the clinical practice as neurologists too. The reduction of sociality is leading most of us to overthink about the self, about relationships, about the place in the world we now occupy or should occupy. Since in this catastrophe Medicine itself is primarily involved, of course our thoughts promptly run to our role as physicians and, more deeply, as neurologists.

Before being Neurologists, we are Physicians and before being Physicians, we are Human. How can we contribute in this COVID-19 outbreak scenario? As human beings, as physicians or as neurologists? Moving fast to the core question, we are asking ourselves the meaning of being a Neurologist in these dark days. To quote Walt Whitman, this is the recurring question.

Neurological clinical practice requires physicality and patient involvement. Indeed, neurological examination implies touching patients for sensory-motor evaluations and being close to them collecting and asking personal information and questions. Additionally, we ask them to imitate us, to walk, to run and to jump. Whether we are not fully convinced from our findings we promptly start over the examination, touching, testing, making them jump again and lately asking to a colleague to reexamine the patient. Among the medical evaluations the neurological examination is probably the one that requires the highest grade of patient active participation, both psychically and mentally. It is somehow hard to adapt this practice to a viral pandemic. We pass through the limbs to go to the nervous system. This is the way we learned to do it. However, we are neurologists, masters of lateral thinking. We face it and we are able to find alternative strategies, but of course, we might risk losing accuracy.

The neurologist, as a physician, has two options. The first one is to keep on taking care of neurological patients that are between the most fragile ones, especially in this period. The second one is to (temporarily) bury the reflex hammer and enlist in Covid-19 task forces. Both choices are equally dignified and virtuous, characterized by arête, the ancient Greek concept of the sense of duty both towards oneself and community.

Both options are strongly challenging. Taking care of neurological patients is trying to be determinant in a known field, acting with new and undefined means. It is the effort to guarantee an adequate health care to our patients, while everything outside seems to fall down. In other words, it is also providing support and instilling hope when everything begins to seem hopeless. Our patients need it and deserve it.

Deciding to face the coronavirus pandemic directly, on the opposite, means to confront ourselves with the unknown. It is being in the eye of a storm completely different from what we are used to. This means getting back into the game, into a new game, ready to risk, to encounter adversities and delusions.

The role of the Neurologist is precisely this. It has always been this: facing uncertainties and adversities, whatever they are. Both choices require qualities that neurology training gave to us. Neurologists are used to challenge complexity and they do it with a favored viewpoint over human behavior and lives. We admit ignorance daily, in the Socratic meaning of ``I know that I know nothing''. We often live with doubts and questions rather than with certainties and answers. The continuous exchange of ideas and opinions is our nourishment.

Decades of battles against fearing diseases with only few and weak weapons has led to the development of diagnostic refinement and elegance probably without equals between medical specialties. It also allowed a wide knowledge of human attitude towards suffering that makes Neurology one of the more human disciplines.

In light of this, deciding to become a Neurologist is a life choice. More than ever, in these frightening, confusing months, the qualities of a good neurologist are strongly needed. This is the meaning of being a neurologist. The answer is that we can contribute as human beings, as physicians and of course as neurologists, waiting to unbury the reflex hammer and the diapason for peaceful periods.

The core question was taken from Walt Whitman's “O Me! O Life!”, we want to conclude with the last lines of the same poem:

_{“The question, O me! So sad, recurring–what good amid}

_{These, O me, O life?}

_Answer

_{That you are here–that life exists and identity,}

_{That the powerful play goes on, and you may contribute}

_{A verse.”}

Declaration of Competing Interest

None.